Inspite of Parkinson’s · 2017. 12. 14. · Parkinson’s is known to alter these brain regions....

Inspite of Parkinson’sA/Prof Sanjay Raghav

What Parkinson’s Taught me

The power of acceptance

• The truth is that not all problems are solvable.

• As much as we’d like to believe otherwise, we don’t have full control over the conditions of our lives.

• But the one thing we do have control over is how we relate to ourselves and the the world around us.

• We accept what is or struggle against it

• Its not giving up or caving in

• But the moment is as it is.

• When we accept what is, we are free. Free to act in accordance with reality. Free to be at peace with the circumstances of our lives, no matter how undesirable or difficult they are.

PREPARES THE

MIND-BODY COMPLEX FOR

PHYSICAL ACTION

TO

AUTONOMIC NERVOUS SYSTEM

EMOTIONAL CORTEX

CONSTRICTS

BLOOD

VESSELS

INCREASED

FORCE OF

CONTRACTION

OF THE HEART

Anger Fear Tension

BP

ADRENALIN

NOR-ADRENALIN

CORTISOL

PROLACTIN

GROWTH HORMONE

THYROXIN

DHEA

Is a

Mandatory

Reflex

for

Survival

IF YOU DON’T ALLOW THE SYSTEM TO REGAIN ITS NORMALCY

A HEALING OVERVIEW

Protection- the Red Zone Growth- the Green ZonePerceived threat/challenge/task Perceived safety/freedom

Stress Response Relaxation Response

Sympathetic N.S. dominant Parasympathetic N.S.Fight/Flight/Withdrawal/Please/Freeze Rest/Digest responseInitiated by HPA axis & SNS Blood flows to digestive system & organs More blood to limbs and hindbrain Physical: Physical:muscular tension muscular tensioncortisol and noradrenaline serotonin and melatoninheart rate, B.P. heart rate, B.P.costal breathing diaphragmatic breathing digestive enzymes digestive enzymesimmune system deregulation immune systemtissue/cell repair and healing tissue/cell repair and healingdigestion/absorption/waste elimination digestion/absorption/eliminationacidity & toxicity oxygenation alkalinity and oxygenationfree radicals and inflammation experience of painsense of pain but general desensitisation sensitisation & sensualitycholesterol and fats in bloodstream/sticky blood tumour angiogenesistelomere shortening genetic instability

Stress & PD

• It has been hypothesized that stress contributes to the development of PD and that depression may exacerbate the symptoms of PD.

• Stress may play a role in the development of PD. The principle risk factor for PD is aging, which may also be associated with elevated levels of cortisol (Gould and Tanapat, 1999).

• Cortisol is elevated in PD patients compared to healthy age-matched controls (Charlettet al., 1998).

• Acute treatment with levodopa can reduce plasma cortisol levels in PD patients (Müller et al., 2007), suggesting a connection between dopamine hypofunction and HPA axis hyperactivity.

• Stressful life events may also precipitate the development of PD. For example, prisoners of war had a much higher incident rate of PD development (Gibberd and Simmonds, 1980).

• Emotional stress can transiently increase motor symptoms (Macht et al., 2007), consistent with acute effects on nigrostriatal function.

Hemmerle et al Exp Neurol. 2012 January ; 233(1): 79–86

Yogic Definition of Stress -

isStress

ÁDHI - THE SEED OF DISEASES

DISTURBED PRÁNA BALANCE

WRONG DIRECTION

WRONG QUANTITIES

CONSTRICTIONS

BLOCKS

HAPHAZARD BREATHING

SETTLES DOWN IN

ANNAMAYA KOSA AS

ORGAN DAMAGE

ÁDHI VYÁDHI

PRANIC IMBALANCE

ÁDHIJA VYÁDHI

ANNAMAYA KOSA

1. Psychic phase MANOMAYA

Psychological warnings

2. Psycho-somatic phase PRANAMAYA

3. Somatic Phase

PRANIC DISTURBANCES

Target organs affected

4. Organic Phase ANNAMAYA

Settles in target organs

Yogah cittavrtti nirdhahSAGE PATANJALI

Yoga is to gain mastery

over the modifications of

the mind

FIVE LAYERED EXISTENCE

OF HUMAN BEINGS

Taittirèya Upanishad has presented this systematically. Man has 5 major sheaths of existence.

ANNAMAYA KOÙA

PRÁÏAMAYA KOÙA

MANOMAYA KOÙA

VIJÒÁNAMAYA KOÙA

Ánandamaya Koùa

The Concept of the Body Structure in Yoga

All of us have five levels of existence

…from gross to subtle..

*Annamayakosa

*Pranamayakosa

*Manomayakosa

*Vignanamayakosa

*Anandamayakosa

The physical structure

The level of life energy

The mental process

The level of discrimination

& choice

The most subtle of all…

pure bliss our REAL state!

NCDs begins in

STRESS -

BEGINS IN MANOMAYA

Sheath

STRESS PRODUCING FACTORS

* Lack of knowledge

* “ ‘I’ness”

* Strong likes

* Strong dislikes

* Fear (of death, situation)

REDUCE THE SPEED

AT ALL LEVELS

MIND SHEATH

ENERGY SHEATH

FOOD SHEATH

Annamaya Kosa

Pranamaya Kosa

Manomaya Kosa

Diet

Kriyas

Asanas

Pranayama

SELF INQUIRY

MEDITATION

Emotion Culture

BLISS SHEATH

WISDOM SHEATH

IAYT

Vijnanamaya Kosa

Anandamaya Kosa

Notional Correction

Happiness Analysis

Karma Yoga

(Action in Bliss)

Yoga

• Yoga brings in:

• Self imposed Lifestyle modification featured by:– Physical activity

– Slow, deep breathing

– Healthy diet habits

– Relaxation

– Positive mental attitude

– Philosophy of life

Cognitive Benefit

• Yoga is as effective as memory enhancement training in improving functional connectivity in relation to verbal memory performance in subject with mild cognitive impairment

[J Alzheimers Dis. 2016;52(2):673-84.]

MODERN MEDICINE, SURGERY

MUSCULAR LEVEL

NERVOUS SYSTEM

CELLULAR LEVEL

NEURO TRANSMITTERS - BRAIN

HENCE ONLY SYMPTOMATIC RELIEF at FOOD

SHEATH

NO “CURE”

Meditation/Mindfulness

Regular Meditation

Deep physical relaxation with undistracted awareness

An effective way to overcome excessive thinking and calm the busy mind

Ancient tool

Why Meditate? Reduces inflammation Reduces cortisol Increases melatonin Reduces metabolic syndrome Improves genetic repair

Reduces number of genetic mutations Improves pain & symptom management Decreases depression, anxiety, distress Improves our ability to cope Improves immune system

Evidence base > 6000 research articles related to benefits of meditation

Me Circuit ! DMN• When the brain is not engaged in goal-directed activities and at rest, there are still measureable patterns of activity. One resting-state network, the default mode network (DMN) is responsible for a self-referential introspective state.

• Active during daydreaming and mind-wandering. But it is also active when the individual is thinking about others, thinking about themselves, remembering the past, and planning for the future.

• Negatively correlated with other networks in the brain such as attention networks.

• There is reduced activation and reduced functional connectivity of the DMN in long-term practitioners.

(Neurosci Biobehav Rev. 2014 Jun;43:48-73) between 2007 and 2014 there were 1384 papers published.

Me Circuit ! DMN

The Mind-Made Me:

roles

images

hopes/wishes/dreams

shoulds/have to’s/ ought to’s/can’ts/musts

stories

histories

dramas

expectations

demands

fears

projections

beliefs

Meditation & Telomeres• Meditation might even slow the ageing process. Telomeres, the protective caps on the ends of chromosomes, get shorter every time a cell divides and so play a role in ageing.

• Clifford Saron of the Center for Mind and Brain at the University of California, recently showed that levels of an enzyme that builds up telomeres were higher in people who attended a three-month meditation retreat than in a control group.

• In Saron’s three-month meditation study, the increase in levels of the enzyme that repairs telomeres correlated with an increased sense of control and an increased sense of purpose in life.

(Psychoneuroendocrinology, vol 36, p 664).

Short-term meditation induces white matter changes in the anterior cingulate, improves self regulation

• The anterior cingulate cortex (ACC) is part of a network implicated in the development of self-regulation and whose connectivity changes dramatically in development.

• In previous studies they showed that 3 h of mental training, (integrative body–mind training, IBMT), increases ACC activity and improves self-regulation.

• Tang group reported that 11 h of IBMT increases fractional anisotropy (FA), an index indicating the integrity and efficiency of white matter in the corona radiata, an important white-matter tract connecting the ACC to other structures. Thus IBMT could provide a means for improving self-regulation and perhaps reducing or preventing various mental disorders.

(Tang et al.vol. 107 no. 35, 15649-15652, 2010 PNAS)

Short-term meditation induces white matter changes in the anterior cingulate

• Demonstration of brain regions with significant FA increases after 11 h of IBMT.

• The demonstration map shows the significant FA increases in the left anterior corona radiata(green area), the left superior corona radiata (purple area), the genu of corpus callosum (blue area), and the body of corpus callosum (red area) after 11 h of IBMT, all P < 0.05.

Brain areas active during meditation

• Evoked Potential studies –Diencephalon

• Imaging studies –– Anterior Cingulate

– Dorso-lateral Prefrontal Cortex

– Regions of limbic systems – Int J Psychophysiol. 2011

May;80(2):103-11

– J Altern Complement Med. 2010 Dec;16(12):1253-8

Mindfulness based intervention in Parkinson’s disease

• Positive link between meditation and Parkinson’s was reported by Pickut and associates in “Mindfulness based intervention in Parkinson’s disease leads to structural brain changes on MRI”.

• In the Parkinson’s group using mindfulness, MRI’s revealed increased grey matter density in several areas of the brain [hippocampus (left and right), amygdala (right), caudate nucleus (right and left), occipital lobe (left), and thalamus (left)]. Parkinson’s is known to alter these brain regions.

• Interestingly, in the Parkinson’s group not using mindfulness, MRI’s revealed increased grey matter density in the cerebellum. These results agree with other data that implies this area of the brain compensates for the other regions that are affected by Parkinson’s.

Meditation EFFECT

• Meditation has been shown to release dopamine in the striatum.

• The hypothesis that meditation might cure or benefit PD patients can be partially explained by it.

A potential case of remission of Parkinson’s disease

• 78-year-old male who, 16 years ago, was diagnosed with Parkinson’s disease (PD) by a neurologist.

• He initially presented with left-hand tremor, stooped posture, shuffling gait, and frequent falls, which eventually progressed to bilateral motor symptoms after 3 years.

• Since 2012, his symptoms and signs have almost completely remitted, and he has been off all pharmacotherapy for that time.

• The accuracy of the initial PD diagnosis is supported by an appropriate clinical presentation, history of positive response to Sinemet, and an abnormal SPECT DaT scan;

• This case suggests the possibility of remission of symptoms in some patients.

• They propose that the patient’s long history of meditation practice may have been one contributing factor of this improvement as meditation has been shown to release dopamine in the striatum.

Smart, K., Durso, R., Morgan, J., et al. (2016). A potential case of remission of Parkinson’s disease . Journal of Complementary and Integrative Medicine, 13(3), pp. 311-315.

Telomeres and aging

Life style modification and telomere activity

Telomerase activity is associated with complex changes in lifestyle

Cell Biology International (2011) 35, 1079–1083

Telomerase and meditation• 30 meditators (mindfulness)

• 6 hours daily for 3 months

• ↑ Telomerase activity in retreat participants compared to controls

• ↑ Perceived Control, ↓Neuroticism, and ↑ in both Mindfulness and Purpose in Life were greater in the retreat group (p < 0.01)

Psychoneuroendocrinology, 2011

Types of MeditationMindfulness-

attention.

Imagery-

intention.

Contemplation-

inquiry.

Mindfulness Meditation

Paying attention in a particular way:

on purpose, in the present moment and

non-judgementally.

(Jon Kabat-Zinn)

Mindfulness is the energy of being aware and awake to the present moment. It is the continuous practise of touching life deeply in every moment.

-Thich Nhat Hanh

Protective Mode to opennessHyperactive threat detector (amygdala).Narrow focus of attention.Excessive thinking.Projection in time & space.Constant doing.The “more” syndrome.Problem saturation.Emotional reactivity or repression.

Choosing to be present byconsciously bringing your attention to here and now experience with:

InterestOpennessReceptivityAcceptancePatienceKindnessPerseverance

God help us to change.

To change ourselves and to change our world.

To know the need for it. To deal with the pain of it.

To feel the joy of it.

To undertake the journey without understanding the destination.

The art of gentle revolution.

Amen.

(Leunig)

The MindTwo Aspects of the Mind:

Active Mind:thinkingacquired/conditioned“monkey” mind

Passive Mind:awarenessobservingsilentoriginal

The thinking mind is a goal-oriented

problem solving mechanism.

----------------------------

“The intuitive mind is our sacred gift

and the rational, thinking mind is a

faithful servant. We have created a

society that honours the servant and

has forgotten the gift.”

(Einstein)

ThinkingThe Nature of Thinking:

Memory and ImaginationCommentary in words and picturesNaming/labellingEvaluatingJudging ComparingAnalysing/interpretingSpeculatingPlanningRecalling

Excessive Thinking-Reactivity:

Fight: Flight:

Blame/resentment Worrying

Guilt /shame Awfulising

Pride/stubbornness Despairing

High expectations Self-pity

Perfectionism Avoiding

Argument Hopelessness

Defending/controlling Helplessness

Intolerance Procrastinating

Righteousness Depression

Holding on

Simplify.

There are only two feelings.

Love and fear.

There are only two languages.

Love and fear.

There are only two activities.

Love and fear.

There are only two motives,

two procedures, two frameworks,

two results.

Love and fear.

Love and fear

(Leunig)

The more consciousness you bring into the body,

the stronger the immune system becomes.

The body loves your attention.

Most illnesses creep in when you are not present in the body.

If the Master is not present in the house, all kinds of shady

characters will take up residence there.

(Eckhart Tolle)

Thinking Awareness

active passive

commentary silent

words/pictures formless

judges non-judgemental

outcomes process

busy/moving still/unchanging

future/past now

acquired original

“the critic” clear/perfect

Emotion

CognitiveInterpretation

AnalysisJudgment

Justifications Distractions

Taking a positionHolding on

Wanting to win/be right

Indulging/DenyingMoods/Attitudes

“The Story”

AffectiveFeelingSensationsBodyEnergyVulnerabilitySensitivity“The Experience”

Meditation Releases:

Fear of:

the unknown

losing control

letting go

being alone

missing out

being nobody

not being wanted

death

NOTHINGNESS

Meditation

• Mindfulness – Being aware

• Dwelling upon positive thoughts

• Remembering enjoyable moments of life

• Being connected with family and friends

• Actively engaging in mental tasks

You don’t stop laughing when

you grow old, you grow old

when you stop laughing

……………. George Bernard Shaw

Spiritual wellbeing

• Spirituality is a very personal matter and something we each feel differently about.

• Often ‘spirituality’ is confused with the structures of formal, organisedreligion.

• Emerging role in health care as potential health benefits spiritual wellbeing can bring.

• Good spiritual health can bring with it a sense of inner peace and comfort.

• Belonging to a faith community, symbolic or ritual practices, meditation, prayer, retreat, pilgrimage, reading scripture, playing or listening to sacred music, Tai Chi, yoga, group activities and engaging with and enjoying the arts and nature.

Spirituality & Parkinson’s

• Being diagnosed with an illness such as Parkinson’s can understandably challenge values and beliefs and affect our spiritual wellbeing.

• Such a life changing event can deepen or alter spiritual beliefs.

• Spiritual strength can help provide a sense of hope for the future and a means of adapting to the way ahead.

Spiritual wellbeing- Benefits

• an awareness and fostering of values such as patience, honesty, kindness, hope, wisdom, joy and creativity

• enhanced confidence and self-esteem

• improved relationships

• a new sense of optimism about life, together with a sense of inner peace and acceptance of problems we face in life

• It can also help to feel at ease with yourself

• give you a new understanding of who you are

• as well as the meaning and purpose of life and the world in which we live.

Spiritual ReliefIn recent years I have detected an interesting phenomenon within myself. I sometimes experience what I call ‘spiritual relief’ from my symptoms. When this happens, my ‘off’ episodes disappear. In other words, my Parkinson’s symptoms withdraw and it is as if they had never existed. The circumstances that result in this relief are generally as follows:

• When I am among friends who love me and I feel their respect

• Whenever I overcome my doubts and lack of confidence and manage to write something valuable, so that even my tough critical self is satisfied with it

• Whenever I participate in a new and challenging task

• When I perform a good deed, such as helping a friend who is suffering a lot

• In other words, the disappearance of symptoms seems to be linked to emotions such as love or fulfilment, or to acts of altruism.

Israeli psychiatrist Ariel Arieli has had Parkinson’s for more than 20 years.

• http://parkinsonslife.eu/dont-worry-be-happy-finding-spiritual-relief-from-parkinsons/#.Wh9niLGtl4k.gmail